Dental Benefits – Claim Instructions - Aetna

1 Dental Benefits Claim Instructions Any person who knowingly and with intent to injure, defraud or deceive any insurance company or other person files an application for insurance or statement of Claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Attention Alabama Residents: Any person who knowingly presents a false or fraudulent Claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof. Attention Arkansas, District of Columbia, Rhode Island and West Virginia Residents: Any person who knowingly presents a false or fraudulent Claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

X-rays taken for metal restorations and crowns should be submitted with treatment plan. They may also be requested for other services. X-rays will be reviewed by practicing Dentists and returned promptly. TO THE EMPLOYEE & DENTIST . Send the completed benefits request and the bills to: Aetna Dental . PO Box 14094. Lexington, KY 40512-4094

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